New Client Form

First Name

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Last Name

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Address

Address Line 1

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Address Line 2

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City

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State

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Postal Code

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Country

Phone Number

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Email

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Date Of Birth

Employer

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Occupation

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Are you a Canadian citizen?

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No

Other

First Name

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Last Name

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Address

Address Line 1

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Address Line 2

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City

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State

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Postal Code

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Country

Phone Number

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Email

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Date Of Birth

Employer

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Occupation

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Are you a Canadian citizen?

Yes

No

Other

Children Information

Please tell me how many children you have.Theire name, age are they in school and how many years left.

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Life Assumptions

What is your planned retirement age for you and spouse if applicable. in current dollars, how much income do you want in retirement?

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Asset Information – Registered Investments

Current value of assets, anual contributon.

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Non-Registered Investments

Current value, anual contributon.

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Corporate Investments

Current value, anual contributon.

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Education Savings

Current value, anual contributon.

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House Value

Please describe and include original cost, current value, mortgage amount.

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Rental Properties

Address, monthly income , mortgage or owned?

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Debt Information

Please include description and amount.

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Income Information

Gross income of all the sources, net income: gross income less expenses.

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Life Insurance

Include company, plan type, amount of coverage and premium.

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Disability

Include company, plan type, amount of coverage and premium.

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Long-term Care

Include company, plan type, amount of coverage and premium.

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Critical Insurance

Include company, plan type, amount of coverage and premium.

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Tell me a bit about your short, medium, and long-term financial goals. What sort of things do you hope to accomplish in the next 1 to 5 years? For example, are you planning to buy a new car? Want to pay off a debt? Rank them in order of importance, from most to least, and attach specific deadlines when possible.

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What about over the next 5 to 10 years? Put a child through school? Save for a major home renovation? Rank them in order of importance, from most to least, and attach specific deadlines when possible.

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And what about things you hope to accomplish 10 years and beyond? When do you hope to retire? Rank them in order of importance, from most to least, and attach specific deadlines when possible.

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Let's review the three categories above. Do you think the goals you've listed above are realistic, or should wording be changed or expectations altered to make sure that the goal is attainable?

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If I asked you to name the financial situations that keep you awake at night worrying, what would they be? Are you concerned about debt? Paying for a future or current expense? Once again, rank these in order of importance for me.

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Where are the flames highest? Could you list the top five financial goals you feel that you'd most like to get accomplished, and give me a date for when you like to get them accomplished by? Can you rank them in terms of priority, from most to least?

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What do you want out of life? Be realistic, but describe the type of lifestyle you'd like to start working towards. The more know about what your personal goals are and the sort of life you want to live, the better I'll be able to help you reach them.

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Co-Client Information